If you have ulcerative colitis (UC), chances are you’ve heard of (and may even use) probiotics — supplements of healthy bacteria that promote digestive health and general well-being. But you may not have heard of probiotics' counterpart, prebiotics.

Prebiotics are substances found in food or supplements that support the growth of probiotics in your digestive system. While they may not get as much attention as the bacteria they support, prebiotics play a crucial role in developing and maintaining a diverse and balanced population of gut bacteria — which may be especially important in people with ulcerative colitis.

Prebiotics are mostly varieties of dietary fiber, which the body’s own digestive juices and enzymes can’t effectively break down — leaving bacteria in the colon to do the job instead.

“Think of your gut as a garden,” says William R. DePaolo, PhD, the director of the Center for Microbiome Sciences and Therapeutics at the University of Washington School of Medicine in Seattle. “If you want to colonize and grow something, you plant seeds. Those seeds would be the probiotics.”

Prebiotics, in contrast, “are the fertilizer you put on that garden,” says Dr. DePaolo. They help healthy bacteria grow and thrive and maintain a stable population in your gut.

The Relationship Between Gut Bacteria and UC

Our intestines are home to 100 trillion microorganisms, which include bacteria, fungi, and other microbes — known collectively as your gut microbiome. Some forms of bacteria (such as lactobacilli and bifidobacteria) are considered positive and helpful, while others (like proteobacteria) can have negative health effects if they become too prevalent.

While the role of gut bacteria in UC isn’t fully understood, it’s clear that people with UC tend to have a different profile of bacteria in their intestines, and that certain differences and changes in the composition of gut bacteria can help predict the course of the disease.

How Prebiotics Can Help

According to DePaolo, people with an IBD like ulcerative colitis are more likely to have an out-of-balance microbiome, a condition known as dysbiosis. This may contribute to disease activity in UC because of the deficiency of compounds produced by healthy bacteria called short-chain fatty acids (SCFAs).

“Short-chain fatty acids are one of the major molecules that regulate inflammation,” says DePaolo, both within the gut and in the body at large. They do this by enhancing the effects of a type of immune system cell — known as a regulatory T cell — that helps regulate other pro-inflammatory T cells.

If you have fewer SCFAs in your body, “you’re going to have less regulation,” says DePaolo, “and that’s going to allow inflammation to be worse.” By helping healthy bacteria grow, prebiotics can help increase SCFAs and reduce inflammation.

While many differences in gut bacteria in people with ulcerative colitis have been found in scientific studies, it’s less clear what effect prebiotics have on these differences, or on disease outcomes.

Good Sources of Prebiotics

A number of different chemical compounds, all of which are indigestible forms of carbohydrate, are known to have prebiotic effects. These include a category of compounds called oligosaccharides, as well as inulin, a form of dietary fiber. The two compounds can be found in various foods, including:

Certain vegetables While most vegetables contain some amount of prebiotics, the best include artichokes, onions, leeks, shallots, garlic, asparagus, sweet corn, beets, and cabbage.

Some vegetables, DePaolo says, have the greatest prebiotic content when they’re consumed raw — including onions, garlic, and leeks. But if raw vegetables irritate your digestive tract, you can help preserve their prebiotic effects by gently steaming them or cooking them as lightly as possible.

Nuts and seeds Almost all nuts and seeds are good sources of prebiotics, including cashews, pistachios, almonds, walnuts, sunflower seeds, and pumpkin seeds. Since many people with UC don’t tolerate whole nuts and seeds well, consider trying nut and seed butters to see if these are easier on your digestive system

Most Americans consume about 50 percent less fiber than is recommended, so DePaolo recommends including as many fiber-rich foods in your diet as possible, as long as you tolerate them well. “Getting [prebiotics] from different sources is good, because there are different types of fiber,” he says. “Variation really covers all your bases.”

If you have trouble tolerating many food sources of prebiotics, it may be worthwhile to try a prebiotic supplement.

Chicory-based supplements may be a good place to start. These products — which include dried chicory, chicory root extract, and inulin (fiber) supplements derived from chicory — tend to contain a mix of both inulin and a type of molecule called oligofructoses, in varying proportions.

Pairing a prebiotic-rich diet or prebiotic supplement with a probiotic supplement may be an even better approach than one or the other, DePaolo says. It may take some time, though, to find a combination of foods and supplements that help relieve your digestive symptoms and make you feel better, so be prepared for some trial and error.

If you decide to explore adding a prebiotic (or probiotic) supplement to your diet, talk to your doctor first to discuss any specific recommendations or reasons why you shouldn’t take such a supplement.

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